130-131). Relationship factors - in the early theoretical models, the level of stress of caregivers was seen as a risk factor that linked elder abuse with care of an elderly relative. While the accepted image of abuse depicts a dependent victim and an overstressed caregiver, there is growing evidence that neither of these factors properly accounts for cases of abuse. Although researchers do not deny the component of stress, they tend now to look at it in a wider context in which the quality of the overall relationship is a causal factor. Today, the belief is that stress may be a contributing factor in cases of abuse but does not by itself account for the entire phenomenon.

Living arrangements, especially those with overcrowded conditions and a lack of privacy have been associated with conflict within families. Even though abuse can occur when the abuser and the older person suffering abuse live apart, the older person is more at risk when living with the caregiver (Krug, 2002, pp. 130-131).

Community and Societal factors - isolation of older people can be both a cause and a consequence of abuse. Many older people are secluded because of physical or mental issues. In addition the loss of friends and family members reduces the opportunities for social interaction.

Although there is little solid empirical evidence, societal factors are currently considered important as risk factors for elder abuse in both developing and industrialized countries. In the past the importance was generally placed on individual or interpersonal attributes as potential causal factors for elder abuse. Cultural norms and traditions such as ageism, sexism and a culture of violence are also now being recognized as playing an important underlying role (Krug, 2002, pp. 130-131).

Prevention

The consequences that physical and psychological violence has on the health of an older person are aggravated by the ageing process and diseases of old age. It becomes more difficult for an elderly person to leave an abusive relationship or to make correct decisions because of the physical and cognitive impairments that usually come with old age. In some instances, kinship obligations and the use of the extended family network to resolve difficulties may also lessen the ability of older people, particularly women, to escape from dangerous situations. Many times the abuser may be the abused person's only source of companionship. Due to these and other things preventing elder abuse presents a whole host of problems for practitioners. In most cases, the greatest dilemma is how to balance the older person's right to self-determination with the need to take action to end the abuse (Krug, 2002, pp. 134-138).

Countries that deliver services to abused, neglected or exploited older people have done so through the existing health and social services network. Such cases frequently involve medical, legal, ethical, psychological, financial, law enforcement and environmental issues. Rules and protocols have been developed to help case workers and special training is usually available to them. Care is often planned by consulting teams drawn from a wide range of disciplines. These services operate in close collaboration with task forces, usually representing statutory bodies and voluntary, private and charitable organizations, that offer consultation services, provide training, develop model legislation and identify weak points in the system (Krug, 2002, pp. 134-138).

In some Latin American and European countries, as well as in Australia, the medical profession has played a leading role in raising public awareness about elder abuse. In other countries, including Canada and the United States, physicians have lagged many years behind the social work and nursing professions. Few intervention programs for abused older people are present in hospital settings. Where they do exist, they are usually consultation teams who are on call in the event a suspected case of abuse is reported. Those involved in health care have an important role to play in programs that screen for and detect abuse (Krug, 2002, pp. 134-138).

Despite a growing interest in the problem, most countries have not introduced specific legislation on elder abuse. Particular parts of abuse are usually covered either by criminal law, or by laws dealing with civil rights, property rights, family violence or mental health. Specific legislation on the abuse of older people would imply a much stronger commitment to eradicating the problem. Even where such laws exist, cases of elder abuse have only rarely been prosecuted. This is principally because older people are usually reluctant -- or unable -- to press charges against family members, because older people are often regarded as being unreliable witnesses, or because of the inherently hidden nature of elder abuse. As long...

134-138).
Educating Professionals and at Home Caregivers

Education and public awareness programs have been vital for informing people in industrialized countries about elder abuse. Education involves teaching new information and changing attitudes and behavior, and is thus a fundamental preventive strategy. It can be conducted in a wide variety of ways -- for instance, in training sessions, seminars, continuing educational programs, workshops, and scientific meetings and conferences. Those who are targeted will include not only practitioners in the various relevant disciplines from medicine, mental health and nursing to social work, criminal justice and religion but also researchers, educators, policy-makers and decision makers (Krug, 2002, p. 138).

It is especially important for professionals to be able to identify that older people are abused and intervene constructively and appropriately. An important first step lies in finding ways to teach clinical staff to reflect on their own attitudes and beliefs about aging and violence in general. It is important for individuals, agencies and communities to critically reflect on their belief systems and examine how these influence their responses to elder abuse (McDonald, Collins and Dergal, 1999, pp. 451-452).

It is critical to introduce more gerontological content in the curriculum of health professionals. In a survey of 155 nursing schools across Canada it was found that a mean of 2.7 hours of instruction was devoted to elder abuse. Incorporating more systematic inclusion of violence content into the curricula is essential to helping to prevent this problem (McDonald, Collins and Dergal, 1999, pp. 451-452).

Education and training programs for caregivers is also essential. Caregiver support groups have a long history as a resource to assist in the care of the elderly, offering mutual support, stress reduction and problem soling strategies. The fundamental assumption is that the combination of social support and education and training will work together to reduce the likelihood that anger, aggression and conflict will emerge in the care giving relationship (McDonald, Collins and Dergal, 1999, pp. 451-452).

Future Direction

After looking at the developments that have occurred in regards to elder abuse and neglect in Canada it can be seen that some progress has been made, but there is still work to be done. Experts feel that in order to move forward there are several key issues that need to be looked and researched further. These include a national incidence study on abuse, a prevalence study on abuse in institutions, case control studies to determine risk factors for abuse and continued testing of screening and assessment instruments, increased education and training of health professionals along with the evaluation of practice, legislation and prevention programs (McDonald, Collins and Dergal, 1999, p. 452). The fact that so many people live to be old is one of the most remarkable achievements of the twentieth century and to be old and live in dignity free from all forms of abuse and violence must be a common goal for all societies of the twenty-first century (WHO/INPEA, 2002).

This is a very important issue that deserves all of the attention and focus that it can get. It is not an issue that is just occurs in Canada but unfortunately happens all across the world. There are many organizations at local levels as well as at national levels that are implanting strategies to try and prevent this abuse from occurring. In order to come up with a solution it is imperative that the problem is first understood to the fullest. Further research is needed so that the problem can completely be understood. Once this is done then and complete and comprehensive plan can be devised on how to prevent this phenomenon from occurring. The fact that elder abuse and neglect happens at all is a very sad but even sadder is the fact that there are civilized nations still allowing it to occur at the rate that it does.